A historical overview of leprosy epidemiology and control activities in Amazonas, Brazil

Leprosy is an ancient infectious disease caused by Mycobacterium leprae. According to comparative genomics studies, this disease originated in Eastern Africa or the Near East and spread with successive human migrations. The Europeans and North Africans introduced leprosy into West Africa and the Americas within the past 500 years. In Brazil, this disease arrived with the colonizers who disembarked at the first colonies, Rio de Janeiro, Salvador and Recife, at the end of the sixteenth century, after which it was spread to the other states. In 1854, the first leprosy cases were identified in State of Amazonas in the north of Brazil. The increasing number of leprosy cases and the need for treatment and disease control led to the creation of places to isolate patients, known as leprosaria. One of them, Colonia Antônio Aleixo was built in Amazonas in 1956 according to the most advanced recommendations for isolation at that time and was deactivated in 1979. The history of the Alfredo da Matta Center (AMC), which was the first leprosy dispensary created in 1955, parallels the history of leprosy in the state. Over the years, the AMC has become one of the best training centers for leprosy, general dermatology and sexually transmitted diseases in Brazil. In addition to being responsible for leprosy control programs in the state, the AMC has carried out training programs on leprosy diagnosis and treatment for health professionals in Manaus and other municipalities of the state, aiming to increase the coverage of leprosy control activities. This paper provides a historical overview of leprosy in State of Amazonas, which is an endemic state in Brazil

Intervenção de base comunitária para a prevenção das DST/Aids na região amazônica, Brasil Community-based intervention to control STD/AIDS in the Amazon region, Brazil

OBJETIVO: Descrever estudo de caso de intervenção de base comunitária, desenvolvido na perspectiva construcionista-emancipatória, para o controle das DST/Aids. MÉTODOS: Estudo descritivo desenvolvido no município de Manacapuru, Amazonas, de 1997-2004, sobre a utilização de procedimentos desenhados em colaboração com agentes governamentais, profissionais de saúde e comunidade. Foram levantados dados sobre a dinâmica da prostituição e a venda de preservativos na cidade, características comportamentais, avaliação do processo e da assistência às DST/Aids. Sincronicamente, estabeleceram-se ações de prevenção e assistência na rede pública de saúde às DST, centro de testagem, sistema de vigilância epidemiológica, e capacitação de trabalhadoras do sexo. RESULTADOS: Observou-se o fortalecimento das trabalhadoras do sexo como multiplicadoras e sua legitimação como cidadãs e agentes de saúde em projetos com travestis, homossexuais e escolares. Houve incremento da venda de preservativos na cidade, da utilização de preservativos entre trabalhadoras do sexo, redução das DST bacterianas e estabilização da ocorrência de infecção pelo HIV/Aids e sífilis congênita. A sustentabilidade do programa de intervenção estudado, organizado no âmbito do Sistema Único de Saude, foi estimulada pela pactuação política garantindo sede e orçamento regulamentado em lei municipal, e pelo debate permanente dos resultados do processo e programa. CONCLUSÕES: O estudo fortaleceu a noção de que o controle efetivo das DST/Aids depende de uma abordagem sinérgica que combine intervenções no plano individual (biológica-comportamental), sociocultural e programático.<br>OBJECTIVE: To describe a case study of community-based intervention, developed in a constructionist-emancipatory framework to control STD/AIDS. METHODS: Descriptive study developed in the town of Manacapuru, in the state of Amazonas, from 1997 to 2004, focusing on procedures designed in collaboration with government agents, health professionals and the community. Data on the dynamics of prostitution and condom sales in this town, preventive practices and STD/AIDS care and process assessment were collected. Actions targeting STD prevention and care in the public healthcare system, a testing center, an epidemiological surveillance system and sex workers' qualification were established concomitantly. RESULTS: It was observed the strengthening of sex workers as peer educators and their legitimization as citizens and health agents in projects involving transvestites, homosexuals and students. There was an increase in condom sales in town, as well as in condom use among sex workers; reduction in bacterial STD; and stabilization of the incidence of HIV/AIDS infections and congenital syphilis. The sustainability of the intervention program studied, organized within the sphere of action of the Sistema Único de Saúde (National Health System), was promoted by a political pact, which guaranteed headquarters and municipal law-regulated budget, as well as by the constant debate over the process and program results. CONCLUSIONS: The study strengthened the notion that effective control of STD/AIDS depends on a synergic approach that combines interventions on individual (biological-behavioral), sociocultural and programmatic levels

A historical overview of leprosy epidemiology and control activities in Amazonas, Brazil

Leprosy is an ancient infectious disease caused by Mycobacterium leprae. According to comparative genomics studies, this disease originated in Eastern Africa or the Near East and spread with successive human migrations. The Europeans and North Africans introduced leprosy into West Africa and the Americas within the past 500 years. In Brazil, this disease arrived with the colonizers who disembarked at the first colonies, Rio de Janeiro, Salvador and Recife, at the end of the sixteenth century, after which it was spread to the other states. In 1854, the first leprosy cases were identified in State of Amazonas in the north of Brazil. The increasing number of leprosy cases and the need for treatment and disease control led to the creation of places to isolate patients, known as leprosaria. One of them, Colonia Antônio Aleixo was built in Amazonas in 1956 according to the most advanced recommendations for isolation at that time and was deactivated in 1979. The history of the Alfredo da Matta Center (AMC), which was the first leprosy dispensary created in 1955, parallels the history of leprosy in the state. Over the years, the AMC has become one of the best training centers for leprosy, general dermatology and sexually transmitted diseases in Brazil. In addition to being responsible for leprosy control programs in the state, the AMC has carried out training programs on leprosy diagnosis and treatment for health professionals in Manaus and other municipalities of the state, aiming to increase the coverage of leprosy control activities. This paper provides a historical overview of leprosy in State of Amazonas, which is an endemic state in Brazil

Leprosy among schoolchildren in the Amazon region: A cross-sectional study of active search and possible source of infection by contact tracing

<div><p>Background</p><p>The high rate of leprosy cases among children under 15 years of age in Brazil indicates ongoing transmission within the community. The identification of the new leprosy cases among contacts can help identify the source of infection and interrupt the transmission chain. This study aims to determine the detection rate of previously undiagnosed cases of leprosy among schoolchildren who are under 15 years of age living in Manaus, Amazonas, Brazil, and their possible source of infection by contact tracing.</p><p>Methodology/Principal findings</p><p>This was a school-based, cross-sectional study in which the identification of active leprosy cases was conducted in 277 out of 622 randomly selected public schools in Manaus, Amazonas, Brazil. Suspected cases of leprosy were referred to the Alfredo da Matta Foundation, a reference center for leprosy in Manaus. A total of 34,547 schoolchildren were examined, and 40 new leprosy cases were diagnosed. Among new cases, 57.5% were males, and 80.0% demonstrated paucibacillary leprosy. A total of 196 of 206 registered contacts were screened, and 52.5% of the newly diagnosed children’s cases had at least one positive household contact. In these contacts, grandparents (52.4%) were the most common co-prevalent cases, while 14.3% were uncles, 9.5% were parents and 9.5% were granduncles. Seven contacts (5.0%), including four siblings of child patients were newly diagnosed. Our data indicate that the prevalence is 11.58 per 10,000, which is 17 times higher than the registered rate.</p><p>Conclusions/Significance</p><p>This study suggests that the detection rate of leprosy among schoolchildren may have remained unchanged over the past thirty years. It also indicates that that active case finding is necessary for reaching the World Health Organization’s goals of zero detection among children, especially in endemic areas where the prevalence of leprosy is obscure. Moreover, we assert that all children must have their household contacts examined in order to identify the possible source of infection and interrupt the disease’s transmission. Novel strategies to reinforce contact tracing associated with large-scale strategies of chemo- and immune-prophylaxis should be expanded to prevent the perpetuation of the disease cycle.</p></div

Genograms of schoolchildren #1, #2, #3, #4, #5, #6, #7, #8 and #9.

<p>Genograms showing the possible source of infection with <i>M</i>. <i>leprae</i> among nine newly diagnosed leprosy cases.</p

Scheme of laboratory tests performed to support clinical diagnosis.

<p>Of the 40 newly diagnosed cases of leprosy, 37 patients received a SSS test, 34 had histopathological examinations, and 26 had a PCR. SB: skin biopsy; SSS: slit skin smear; I: indeterminate; TT: tuberculoid-tuberculoid; BT: borderline-tuberculoid; BL: borderline-lepromatous; LL: lepromatous-lepromatous; MB: multibacillary; and PB: paucibacillary leprosy.</p

Clinical and epidemiological aspects of the 40 newly diagnosed cases of leprosy among schoolchildren in Manaus, Amazonas, Brazil.

<p>Clinical and epidemiological aspects of the 40 newly diagnosed cases of leprosy among schoolchildren in Manaus, Amazonas, Brazil.</p

Perfil nosológico de centro de referência em dermatologia no estado do Amazonas - Brasil Nosological profile in a dermatology referral center in the state of Amazonas -Brazil

FUNDAMENTOS: As doenças de pele estão associadas a alta morbidade, baixa mortalidade e baixa proporção de hospitalização. Entretanto, podem causar considerável interferência no bem-estar físico e emocional do indivíduo. Várias delas atingem grandes contingentes populacionais, havendo necessidade de intervenções específicas para seu controle. OBJETIVO: Descrever a frequência das dermatoses diagnosticadas em serviço de dermatologia na cidade de Manaus, capital do estado do Amazonas. MÉTODOS: Coletaram-se dados registrados sobre sexo, idade, procedência e diagnósticos referentes à primeira consulta dos pacientes atendidos entre janeiro de 2000 e dezembro de 2007. RESULTADOS: Das 56.024 consultas registradas, obtiveram-se 56.720 diagnósticos dermatológicos, sendo mais comuns as doenças sexualmente transmissíveis (25,12%), as dermatoses alérgicas (14,03%), as dermatoses não especificadas (13,01%), a hanseníase (6,34%) e acne, seborreia e afins (5,05%). A frequência foi semelhante para ambos os sexos, a faixa etária de 20-29 anos foi predominante e Manaus foi a procedência mais referida. CONCLUSÕES: O padrão das doenças cutâneas identificadas neste estudo pode servir como linha de base para que gestores do sistema de saúde da região desenvolvam estratégias de prevenção e controle das dermatoses mais comuns, com ênfase nas doenças sexualmente transmissíveis, doenças cutâneas alérgicas, hanseníase e acne<br>BACKGROUNDS: Fundaments: Skin diseases are associated wih high morbidity, low mortality and low rate of hospitalization. However, they can cause considerable interference in physical and emotional well-being of the individual. Several of them reach large population, requiring specific interventions for their control. OBJECTIVE: To describe the frequency of skin disease diagnosed in the dermatology service in Manaus, capital of Amazonas State. METHODS: We collected data on registered sex, age, origin and diagnostics for the first consultation of patients attended between January 2000 and December 2007. RESULTS: Of the 56.024 recorded visits, we obtained 56.720 cases of dermatological diagnoses, being the most common sexually transmitted diseases (25,12%), allergic skin disesases (14,03%), unspecified dermatoses (13,01%), leprosy (6,34%) and acne, seborrhea and related diseases (5,05%). The frequency was similar for both sexes, aged 20-29 years predominated and Manaus the origin most reported. CONCLUSIONS: The pattern of skin diseases identified in this study may serve as a baseline to managers of health system in the region develop strategies for prevention and control of dermatoses, with emphasis on sexually transmitted diseases, allergic skin diseases, leprosy and acn